Objective To explore the clinical manifestations,diagnosis,misdiagnosis and treatment of primary hyperparathyroidism.Methods The clinical data of 36 patients with primary hyperparathyroidism admitted into the First Affiliated Hospital of Chongqing Medical University from January 2009 to October 2014 were reviewed and analyzed retrospectively.Results The manifestations of primary hyperparathyroidism were various and atypical.Primary hyperparathyroidism was often misdiagnosed as other diseases by 25.0％ (9/36).Among the patients,the ratio of male to female was 1:1,and median age was 58 years old.Of all patients,there were 9 persons with joint pain,digestive system symptoms in 7 cases,cervical mass discovered in 6 cases(3 cases were found when B ultrasonic examination),urinary calculus in 5 cases,fatigue symptoms in 4 cases,osteoporosis and urinary calculus in 2 cases,1 case with fracture,2 cases without any symptoms.Their calcium and parathyroid hormone level were increased by various degree.The accuracy rates of level diagnosis of Color Doppler ultrasound combine with CT or 99Tcm-MIBI were improved obviously,85.2％ and 93.1％ respectively.Twenty-eight patients received surgical treatment and pathology examination confirmed the accurate pathological types after surgery.There were 23 cases of parathyroid adenoma,1 case parathyroid hyperplasia,1 case parathyroid carcinoma,2 cases of parathyroid adenoma with nodular goiter,parathyroid adenoma merged thyroid carcinoma in 1 case.Serum calcium and parathyroid hormone level declined obviously after operation.The other 8 patients received non-surgical treatment,7 cases were alleviated and 1 case died due to irreformable high blood calcium crisis.Conclusion There should be pay attention to recognize primary hyperparathyroidism,check the blood calcium,and about suspected cases should be performed as early as parathyroid tested,neck color Doppler ultrasound.Early surgical treatment can significantly improve the prognosis and quality of life.

Objective To explore the value of serum chromogranin A (CgA) in clinical diagnosis and efficacy evaluation of gastroenteropancreatic neuroendocrine neoplasm (GEP-NEN).Methods From January 2011 to December 2012,87 GEP-NEN patients were enrolled,which included 50 patients with lesions and 37 patients without lesions after surgery.Eighty-four healthy subjects were taken as control group.The serum CgA levels of all subjects were measured with enzyme linked immunosorbent assay.Nonparametric test,receiver operating characteristic curve and Cox regression univariate analysis were performed for analysis.Results The median of serum CgA level of GEP-NEN patients with lesions was 97μg/L,which was significantly higher than that of patients without lesions after surgery (42 μg/L,Z=3.451,P=0.001) and healthy control (47 μg/L,Z=3.149,P=0.002).The value of 95 μg/L was taken as diagnostic cut-off value for healthy controls,patients without lesions and patients with lesions,the sensitivity and specificity were 54.0％ and 90.1％,respectively.The median of serum CgA level of the patients with distant metastasis was 231 μg/L,which was higher than that of patients without distant metastasis (46 μg/L,Z=3.340,P=0.001).After treatment,the serum CgA levels of 12 patients with complete remission,partial remission or stable tumor decreased more than 20％ of baseline values.The serum CgA levels of five patients increased more than 20 ％ of baseline values and the tumors of them showed progress.Cox regression analysis showed that there was no correlation between CgA levels of patients with lesions and prognosis (r=1.000,P=0.252).Conclusion Neuroendocrine marker CgA has high diagnostic value in GEP-NEN,and can be used as an important biomarker in clinical diagnosis and efficacy evaluation of GEP-NEN.

Objective To explore the expression,correlation and clinical significance of mammalian target of rapamycin (mTOR) and vascular endothelial growth factor (VEGF) in gastroenteropancreatic neuroendocrine neoplasm (GEP-NEN).Methods From October 1995 to December 2012,the paraffin tissue specimens of 114 pathological diagnosed GEP-NEN were collected.The expressions of mTOR and VEGF at protein level were detected with EnVision immunohistochemical staining method.Chi-square test was performed to compare the differences in the expressions of mTOR and VEGF among every clinicopathological factors of patients.Spearman's correlation analysis was used to find out the correlation between the expressions of mTOR and VEGF.Kaplan Meier method and Log-rank test were implemented for survival analysis.Results The overall positive expression rates of mTOR and VEGF in GEP-NEN tissues were 66.7％ (76/114) and 71.1％ (81/114),respectively.The expressions ofmTORand VEGF at protein level were not correlated with gender,age,functional status of tumor,location of tumor,grading and classification of tumor and distant metastasis (all P＞0.05).The co-expression rate of mTOR and VEGF in GEP-NEN tissues was 51.8％ (59/114).The expression of mTOR was positively correlated with the expression of VEGF at protein level (r=0.205,P=0.029).Among 82 followed-up patients,the mean survival time of patients with mTOR positive or negative expression was 8.3 and 7.9 years,and respectively,and there was no statistical significance (x2 =0.201,P=0.654).The mean survival time of patients with VEGF positive or negative expression was 9.6 and 5.9 years,respectively,and the difference was statistically significant (x2 =4.415,P=0.036).Among the patients with G1 grading tumor,classified as neuroendocrine tumor and without distant metastasis,the survival time of patients with positive VEGF expression was longer than that of patients with negative VEGF expression (11.8 years vs 7.3 years,x2 =5.349,P=0.021; 11.2 years vs 6.8 years,x2=6.375,P=0.012; 11.2 years vs 7.2 years,x2 =4.630,P=0.031).Conclusions mTOR and VEGF proteins are highly expressed in GEP-NEN with different location,grading and classification.The expression of them is positively correlated.The prognosis of GEP-NEN patients with positive VEGF expression is better.

Objective To investigate the effects of anxiety ,depression and life events on patients with non-erosive gastroesophageal reflux disease (NERD) .Methods From November 2016 to December 2017 ,at The First Affiliated Hospital of the Medical College ,Shihezi University ,135 patients with NERD (NERD group) and 133 volunteers who received physical examination at the same period were enrolled (healthy control group) .The scores of self-rating anxiety scale (SAS) ,self-rating depression scale (SDS ) ,life event scale (LES ) and gastroesophageal reflux disease questionnaire (GerdQ ) of the enrolled individuals were obtained by questionnaire .Mann-Whitney ranking test ,chi square test and Spearman rank correlation test were performed for statistical analysis .Results The patients with anxiety in NERD group accounted for 46 .67％ (63/135) ,which was higher than that in healthy control group (1 .50％ ,2/133) ,and the difference was statistically significant (χ2 =74 .38 , P< 0 .01) .The patients with depression in NERD group accounted for 12 .59％ (17/135) ,which was higher than that of healthy control group (0 ,0/133) ,and the difference was statistically significant (χ2 = 17 .88 ,P< 0 .01) .The SAS score of NERD group was 48 points (45 points ,52 points) ,which was higher than that of healthy control group (37 points (33 points ,43 points)) ,and the difference was statistically significant (Z=-11 .03 ,P<0 .01) .The SDS score of NERD group was 46 points (41 points ,50 points) ,which was higher than that of healthy control group (36 points ,32 points to 40 points) ,and the difference was statistically significant (Z= -11 .03 , P<0 .01) .The LES score of NERD group was 32 points (10 points ,45 points) , which was higher than that of healthy control group (3 points ,0 points to 32 points) ,and the difference was statistically significant (Z= -2 .18 ,P=0 .03) .The score of LES negative events in NERD group was 21 points (3 points ,36 points) ,which was higher than that of the healthy control group (0 points ,0 points to 23 points) , and the difference was statistically significant (Z= -2 .19 , P=0 .03) .GerdQ score was positively correlated with SAS ,SDS ,LES scores and LES negative event score ,and the differences were all statistically significant (r=0 .65 ,0 .60 ,0 .29 and 0 .29 ,all P< 0 .05) .Conclusions Anxiety ,depression and life events are the influencing factors of NERD .The greater the impact of anxiety ,depression and life event (especially negative live events) ,the more severe the NERD symptoms .

Sarcopenia is observed to have age-related loss of skeletal muscle mass, muscle strength and physical performance, which can be an effective prognostic indicator for postoperative complications and poor survival outcomes in tumor patients. Sarcopenia could reflect tumor-host interactions and has the advantages in accuracy and generality compared with traditional predictors. This paper reviews the research progress of sarcopenia in predicting the prognosis of genitourinary tumors.

Spinal cord injury is a catastrophic injury causing lifelong severe disabilities, and poses a great burden to the individuals, families and society. In order to promote the standardization in treatment of traumatic spinal cord injury, the consensus on the evaluation, treatment and rehabilitation of traumatic spinal cord injury was suggested by experts, who came from authoritative multicenter in China. The expert consensus, which formed a standardization process from the first aid clinical treatment to rehabilitation of spinal cord injury, shall give a better practical guide for clinic and rehabilitation physicians.

Objective:To evaluate the pancreatic subclinical dysfunction after intensity-modulated radiation therapy (IMRT) for gastric cancer by analyzing biochemical indexes and pancreatic volume changes, and to reduce the dose of pancreas by dosimetric prediction and dose limitation.Methods:30 patients with gastric cancer who received 45 Gy postoperative adjuvant radiotherapy were retrospectively selected. The pancreas was delineated and its dose and anatomical relationship with planning target volume (PTV) were evaluated. Fasting blood glucose, serum lipase and amylase, and pancreatic volume changes before and after radiotherapy were analyzed. The correlation between the changes of biochemical indexes and volume and pancreatic dose was evaluated by Pearson analysis. The threshold of the dosimetric prediction was obtained by receiver operating characteristic (ROC) curve. Finally, the feasibility of dosimetric limitation in IMRT was assessed.Results:The pancreatic volume of 30 patients was 37.6 cm 3, and 89.0% of them were involved in PTV. D mean of the pancreas was 45.92 Gy, and 46.45 Gy, 46.46 Gy and 45.80 Gy for the pancreatic head, body and tail, respectively. The fasting blood glucose level did not significantly change. The serum lipase levels were significantly decreased by 66% and 77%(both P<0.001), and the serum amylase levels were significantly declined by 24% and 38%(both P<0.001) at 6 and 12 months after radiotherapy. Pancreatic volumes of 22 patients was decreased by 47% within 18 months after radiotherapy. ROC curve analysis showed that pancreatic V 45Gy had the optimal predictive value for the decrease by 1/3 of serum lipase and amylase levels at 6 months and serum amylase level at 12 months after radiotherapy, and the cut-off value was V 45Gy<85%. Pancreatic D mean yielded the optimal predictive value for the decrease by 2/3 of serum lipase level at 12 months after radiotherapy, and the cut-off value was D mean<45.01 Gy. After" whole pancreas" and" outside PTV pancreas" dose limit, V 45Gy of the pancreas was decreased by 11% and 7%, D mean of the pancreas was declined by 2% and 2%, and D mean of the pancreatic tail was decreased by 3%, respectively. Conclusions:Serum lipase and amylase levels significantly decline at 6 and 12 months after adjuvant radiotherapy for gastric cancer, and pancreatic volume is decreased significantly within 18 months after radiotherapy. Pancreatic V 45Gy<85% and D mean<45.01 Gy are the dose prediction values for the decrease of serum lipase and amylase levels. The dose can be reduced to certain extent by dosimetric restriction.

ObjectiveTo observe the effect of Coptidis Rhizoma and Ophiopogonis Radix on renal tissue injury and epidermal growth factor receptor （EGFR）/phosphatidylinositol 3-kinase （PI3K）/protein kinase B （Akt） signaling pathway in rats with diabetic nephropathy （DN） and explore its possible mechanism of delaying DN. MethodThirty-six male Wistar rats were randomly divided into a normal group （6 rats） and a model group （30 rats）. The model group was fed with a high-fat and high-sugar diet combined with streptozotocin （STZ） to establish a rat model of type 2 diabetes. After the successful preparation of the model， the rats were randomly divided into the model group， low， medium， and high dose groups of Coptidis Rhizoma and Ophiopogonis Radix （100， 200， 400 mg·kg^-1）， and metformin group （200 mg·kg^-1）. After administration， the levels of fasting blood glucose （FBG）， 24 h urine protein （24 h-UTP）， creatinine （SCr）， urea nitrogen （BUN）， and uric acid （UA） were detected. Hematoxylin-eosin （HE） staining and Masson staining were used to observe the pathological changes of renal tissue in rats. Western blot and Real-time fluorescence quantitative polymerase chain reaction （Real-time PCR） were used to detect the related protein expression of EGFR， PI3K， and Akt and their mRNA expression levels in the renal tissue of rats in each group. ResultsCompared with the normal group， the levels of FBG， SCr， BUN， UA， 24 h-UTP， and kidney index in the model group were significantly increased （P<0.01）， most renal tubular epithelial cells were necrotic， and the content of collagen in glomeruli was significantly increased （P<0.01）. Compared with the model group， the above indexes of rats in each administration group were improved to varying degrees. The FBG， SCr， BUN， UA， 24 h-UTP， and kidney index of rats in each dose group and metformin group were significantly decreased （P<0.01， P<0.05）. The necrosis degree of renal tubular epithelial cells was reduced， and the fibrosis area was decreased （P<0.01）. There related protein and mRNA expressions of EGFR， PI3K， and Akt were significantly increased （P<0.05， P<0.01）. ConclusionCoptidis Rhizoma and Ophiopogonis Radix can alleviate renal tissue injury in rats with DN， and their mechanism may be related to the regulation of the EGFR/PI3K/Akt signaling pathway.